Ann Arbor Charter Township
3792 Pontiac Trail Ann Arbor, MI 48105
734-663-1855
www.aatwp.org
Certificate of Zoning Compliance-Land Use Permit
_____________________________________________
Date received___________________________
(applicant)
(for office use only)
_____________________________________________
___________________________________________
(address
(City, State, Zip Code)
____________________________________________
_________________________________________
(telephone)
(email)
PROPERTY OWNER’S NAME AND ADDRESS (if not the applicant)
__________________________________________________________________________________________________
___________________________________________________________________________________________________
Email___________________________________________
Phone_____________________________________
If you are not the property owner attach a duly verified affidavit of the owner that the proposed work is authorized by the
owner and you are authorized to make this application.
SITE ADDRESS________________________________________________________________________________
PARCEL ID_________________________________ PARCEL SIZE_______________________________________
PROVIDE 2 COPIES OF REQUIRED SITE PLAN FOR THE PROPOSED PROJECT, INCLUDING:
1. Scale, date, and north point
2. Location, shape, and dimensions of lot
3. Dimensioned location, outline, and dimensions of all existing and proposed structures, and the location and extent of
all uses not involving structures
4. A clear description of existing and intended uses of all structures
5. If in flood hazard area, all information required by floodplain management ordinance
AFFIDAVIT: I agree the statements made above are true, and if found not to be true, any zoning permit that may be issued may be void.
Further, I agree to comply with the conditions and regulations provided with any permit that may be issued. Further, I agree the permit
that may be issued is with the understanding that all applicable sections of the Ann Arbor Township zoning Ordinance will be complied
with. Further, I agree to notify the zoning official of Ann Arbor Township for inspection before the start of construction and when
locations of proposed uses are marked on the ground. Further, I agree to give permission for officials of Ann Arbor Township,
Washtenaw County and the State of Michigan to enter the property subject to this permit application for purposes of inspection.
Finally, I understand this is a zoning permit application (not a permit) and that a zoning permit, if issued, conveys only land use rights,
and does not include any representation or conveyance of rights in any other statute, building code, deed restriction or other property
rights.
Signed:____________________________________________________
Date:___________________________
THIS PAGE TO BE COMPLETED BY TOWNSHIP
Property description__________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Issued to: __Owner __Other__________________________________________________
Land use allowed by this permit_________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Size of building, structure, addition______________________________________________________
Zoning classification of site____________________________________________________________
Lot size and width requirements________________________________________________________
Min. setbacks (required/proposed):
Front_______________________Rear_______________________Side________________________
Ground floor coverage (required/proposed):
_________________________________________________________________________________
Floor area ratio (required/proposed):
_________________________________________________________________________________
Attachments________________________________________________________________________
___________________________________________________________________________________
Signed:______________________________________________________
(Zoning Official)
Date_______________________